Provider Demographics
NPI:1225001258
Name:SPENCER, DONNA M (CNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:SPENCER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:COMMERCIAL POINT
Mailing Address - State:OH
Mailing Address - Zip Code:43116-0329
Mailing Address - Country:US
Mailing Address - Phone:614-877-9175
Mailing Address - Fax:
Practice Address - Street 1:5 MAIN STREET
Practice Address - Street 2:
Practice Address - City:COMMERCIAL POINT
Practice Address - State:OH
Practice Address - Zip Code:43116-0329
Practice Address - Country:US
Practice Address - Phone:614-877-9175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-06040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2464346Medicaid